Health In All Policies Workgroup issues 2023 recommendations
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The United Nations designates housing as a key public health issue, “the basis of stability and security for an individual or family…the center of our social, emotional and sometimes economic lives.”
In the State of Illinois, affordable and accessible housing remains a fundamental community need. Illinois’ Health In All Policies Workgroup, co-led by the Illinois Department of Public Health and the UIC School of Public Health, focused on the state’s housing needs and connections to improving health in its 2023 annual report to the Illinois General Assembly.
Policy sectors for housing and health rarely operate in parallel, the report notes, even though housing is a primary determinant of health. Illinois faces numerous challenges toward sustainable housing access. Using annual point-in-time data, homelessness increased significantly across nearly all subpopulations from 2022 to 2023, after a decline from 2018 to 2022. Housing instability is another challenge in the state, particularly in the face of rising rents. At Illinois’ minimum wage, a worker would need to work 65 hours per week to afford a one-bedroom rental at fair market rent, the equivalent of 1.6 full-time jobs.
Among rental properties, evictions remain prevalent, at a rate of about 2.9 evictions per 100 renters. The highest rates are concentrated in Rockford, Joliet and Peoria. Two-thirds of eviction cases are brought outside Cook County, even though most Illinois renters live in Cook County.
Home ownership in Illinois increased by 1.1 percent from 2022 to 2023 and remains slightly higher than national averages. A shortage of homes for sale and new construction of housing impacts Illinois’ home ownership rate.
Illinois’ housing situation, like in every state across the country, is impacted by lack of federal investment, discriminatory policies and practices and lingering effects of the COVID-19 pandemic.
Housing access impacts numerous community health issues but also drives clinical outcomes for individuals. Homeless populations are at increased risk of temperature-related injuries resulting in longer hospital stays, increased mortality and surgical amputation of extremities. The majority of people experiencing homelessness have psychiatric comorbidities of depression, psychosis and/or substance abuse. Housing instability contributes to poorer self-reported health and increased prevalence of chronic medical conditions in adults, as well as increased risk of physical abuse and subsequent hospitalization, poor diet and elevated cortisol levels in children.
Using a health in all policies framework, the report contains key recommendations for addressing housing instability and homelessness:
- Appropriate funds to the expansion of permanent supportive housing models, particularly those guided by the Housing First philosophy.
- Evidence shows that Housing First program outcomes include faster housing placements, increased rates of housing stability and housing retention, along with decreases in costly shelter use, annual costs, monthly hospital visits and jail stays.
- Provide support to demonstration projects that maximize use of Medicaid funds for housing.
- Federal match rates for expenses tied to medical and administrative activities for Medicaid/CHIP recipients can be 50-90%. Creating benefits for people who are Medicaid eligible helps ensure broader service coverage for low-income populations most at risk for homelessness and housing insecurity.
- Improve collection, quality and dissemination of data that connects housing insecurity, homelessness and evictions to morbidity and mortality.
- Incorporating housing stability inquiries into health intake screenings, adding housing status to medical records, and developing key performance indicators for health and housing are cited among potential actions to increase availability of timely data to inform decisions and assessments of interventions that address homelessness and housing instability.